Genetic literacy among primary care physicians in a resource-constrained setting.

Background: Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to develop curricula for continuing professional development of non-geneticists. Scarce data is available from resource-constrained countries in Middle East and North Africa.

Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health.

An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate.

Knowledge, attitudes, and practices of pediatricians in relation to breastfeeding support: A national survey in Lebanon.

Background: Rates of breastfeeding (BF) remain suboptimal despite overwhelming evidence for its benefits to the mother and child. Pediatricians play an important role in supporting breastfeeding (BF). In Lebanon, the rates of both exclusive and continued BF are critically low.

Interventions addressing genetic disease burdens within selected countries in the MENA region: a scoping review.

Background: The MENA region is disproportionately affected by genetic disease. The aim of this research is to scope the region for evidence of genetic services and public health interventions to identify geographic gaps, and to provide a descriptive overview of interventions to identify knowledge gaps.

Methods: This study is conducted as a scoping review and follows the Arksey & O'Malley scoping review framework.

Developing Capacity in Dissemination and Implementation Research in the Eastern Mediterranean Region: Evaluation of a Training Workshop.

Unlabelled: As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the complex process of bridging research and practice in a variety of real-world settings, and (2) develop research that balances rigor with relevance and employs study designs and methods appropriate for the complex processes involved in D&I. The present exploratory study investigates participants' satisfaction with the workshop, the enhancement of their self-rated confidence in D&I skills, as well as their intention to apply the learned content into practice.

Teaching Social Marketing Using E-Service Learning Amidst Health and Humanitarian Crises: A Case Study from Lebanon.

We present the design, implementation, and evaluation of an e-service learning course, "Social Marketing for Health Promotion", offered to full-time and part-time students enrolled in the Master of Public Health at our institution. In a quasi-experimental trial, we introduced e-service learning in 2018, comparing a traditional face-to-face section to a blended course (33% online). Based on the positive feedback received, we progressively increased the online component in the following academic years, reaching 100% online in Fall 2020.

"A person who does not have money does not enter": a qualitative study on refugee women's experiences of respectful maternity care.

Background: Women's childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women's perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems.

Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth.

Background: Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region.

Maternal mortality in Lebanon: Increased vulnerability among Syrian refugees.

Objective: To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018.

Methods: A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of Public Health in Lebanon during the period of 2010-2018. Maternal deaths among Syrian refugees and Lebanese citizens were compared based on cause of death, age of the woman, and nationality.

Trends, wealth inequalities and the role of the private sector in caesarean section in the Middle East and North Africa: A repeat cross-sectional analysis of population-based surveys.

Objective: To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in the Middle East and North Africa (MENA).

Methods: Secondary data analysis of nationally representative household surveys conducted between 2008-2020 across nine Arab countries in the MENA region. The study population was women aged 15-49 years with a live birth in the two years preceding the survey.

Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review.

Background: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information.

Analyzing the social context of health information and misinformation during the COVID-19 pandemic: a case of emerging inequities in Lebanon.

With the far-reaching COVID-19 pandemic starting in December 2019, a surge of misinformation, now coined by the World Health Organization (WHO) as an 'infodemic', has also taken the world by storm. False information and variations in interpretations about the pandemic and mitigation interventions/strategies continue to spread at a faster pace than the relevant scientific evidence. The WHO has called for a fight against this infodemic, describing it as the most contagious aspect of the pandemic.

Global research priorities for social, behavioural and community engagement interventions for maternal, newborn and child health.

Background: Social, behavioural and community engagement (SBCE) interventions are essential for global maternal, newborn and child health (MNCH) strategies. Past efforts to synthesise research on SBCE interventions identified a need for clear priorities to guide future research. WHO led an exercise to identify global research priorities for SBCE interventions to improve MNCH.

Integration of sexual and reproductive health services in the provision of primary health care in the Arab States: status and a way forward.

Different approaches are used for integration of sexual and reproductive health (SRH) services at the primary health care (PHC) level, aiming at providing comprehensive services leaving no one behind. This paper aims to assess gaps in the delivery of SRH in PHC services, identifying challenges and proposing action towards universal health coverage in Arab countries. The United Nations Population Fund, Arab States Regional Office (UNFPA/ASRO), in partnership with Middle East and North Africa Health Policy Forum (HPF), launched an assessment of integration of SRH into PHC in 11 Arab countries in 2017-2018.

Experiences with peer support for breastfeeding in Beirut, Lebanon: A qualitative study.

Background: Despite the beneficial effects of peer support on breastfeeding, research on the process of peer support is scarce. In Lebanon, exclusive breastfeeding is only 15% in infants below six months. A multidisciplinary team launched a multi-component breastfeeding support intervention, with peer support, and professional lactation support provided by International Board Certified Lactation Consultants (IBCLs) to target this decline.

A review of maternal mortality trends in Lebanon, 2010-2018.

Lebanon invested in the prevention of maternal mortality after the civil war, which left a deficient vital registration system leading to unreliable estimates of maternal mortality ratio (MMR). Starting in 2004, the Ministry of Public Health integrated reproductive health into primary health care and established a national notification system of maternal and neonatal deaths. From 1990 to 2013, Lebanon achieved an annual change in MMR of -7.

A multi-component intervention to support breastfeeding in Lebanon: A randomized clinical trial.

Background: Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care.

Methods: This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188).

Implementation of a labour companionship model in three public hospitals in Arab middle-income countries.

Aim: To assess the feasibility, acceptability, effectiveness and cost of the integration of a tailored labour companionship model in three public hospitals in Egypt, Lebanon and Syria.

Methods: Phased implementation research using mixed methods. Implementation strategies consisted of steering committees in hospitals, seminars for healthcare providers, information, education and communication materials, and adjustments in labour rooms.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon.

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex.

Women's satisfaction and perception of control in childbirth in three Arab countries.

Women's satisfaction and perceived control in childbirth are important attributes of the childbirth experience and quality of care indicators. This article presents findings from the pre-intervention phase of a multi-centre implementation study in Egypt, Lebanon and Syria, to introduce a labour companionship model in these countries. A sample of 2620 women giving birth in three public teaching hospitals from November 2014 to July 2015 in Beirut and Mansoura, and from November 2014 to April 2015 in Damascus were interviewed by trained field workers.

Companion of choice at birth: factors affecting implementation.

Background: Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators.

Methods: Forty one published studies were included in this review.

Validation of three Arabic health literacy assessment tools in Lebanon.

Health literacy is an important predictor of health status, health behaviours, and other health outcomes. However, research on health literacy in the Arab world is scarce and no health literacy tool has been validated to test the health literacy level of the Lebanese population so far. The aim of this study was to validate Arabic translations of three commonly used health literacy assessment tools, the S-TOFHLA, the REALM-R, and the Brief Health Literacy Screening items.

Perceptions about labor companionship at public teaching hospitals in three Arab countries.

Objective: To explore the perspectives of women, female relatives, and healthcare providers on labor companionship.

Methods: In a qualitative study, data were collected from women giving birth, female family members, and healthcare staff via semi-structured interviews in three large public teaching hospitals in Beirut (Lebanon), Damascus (Syria), and Mansoura (Egypt) between May and December 2012. Focus groups were conducted with midwives, nurses, and medical residents.

Mode of delivery and pain during intercourse in the postpartum period: findings from a developing country.

Objective: This study examines the association of the reporting of pain during intercourse in the postpartum period with mode of delivery, and describes women's reports of pain during intercourse and their health care seeking behavior over a period of 40 days-6 months postpartum.

Methods: A cross-sectional study recruited women in their 2nd and 3rd trimester of pregnancy from private obstetric clinics affiliated with 18 hospitals in two regions of Lebanon. Face-to-face interviews using a structured questionnaire were conducted at the women's homes from 40 days to 6 months postpartum.